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Am I on the right Thyroid Medication? (hypothyroidism, Hashitmoto's thyroiditis)

When I was first diagnosed with Hashimoto’s thyroiditis, a type of autoimmune thyroid disease that resulted in low functioning thyroid, I was a year into naturopathic medical school and had yet to learn all the drug therapies out there. It’s not been almost a decade and I now have exposure and experience (both personally and professionally as a clinician) with different types of medications. This is what I will discuss below. The intent of this article is to inform you, the reader, with your options as there are so many options when it comes to supplemental thyroid hormone. I know what it’s like to be on this journey, this information is to help serve you and help you find the best options for you!

Please note that I will not get into naturopathic treatments of Hashimoto’s, generally low thyroid function, or other forms of thyroid disease here as that is a hefty topic for another article. :)

What is hypothyroidism?

Hypothyroidism is a low functioning thyroid. This means that your thyroid is not producing enough thyroid hormones to help you maintain normal physiological function. This often results in fatigue, weight gain, mood swings, constipation, brain fog, dry skin & brittle nails, depression, low libido, and poor lipid metabolism.

What causes hypothyroidism?

A low functioning thyroid can be due to a multitude of different causes. One of the most common causes I see in my practice is Hashimoto’s thyroiditis which is autoimmune induced destruction of the thyroid that leads to hypothyroidism. Other causes include: congenital, medication induced, pituitary or hypothalamic issues (areas of the brain that signal to the thyroid), or post-radiation of neck (leads to damage to thyroid). Subclinical hypothyroidism is also a cause of symptoms of low thyroid function, in this case circulating thyroid hormone labs look normal but the TSH (signal from the brain to the thyroid) is abnormal and a ‘signal’ that dysfunction is starting to occur and you may benefit from thyroid replacement therapy.

What is an autoimmune disease?

This is where your immune system attacks your own body’s tissue. There are multiple different types of autoimmune diseases. In Hashimoto’s the body mistakes the thyroid gland as ‘forgeign tissue’ and tags it with antibodies (anti-thyroperoxidate and anti-thyroglobulin) and attacks it.

What is supplemental thyroid hormone?

When the body is unable to produce enough of its own thyroid hormone, it requires supplemental thyroid hormone to achieve normal physiological levels. As a naturopathic doctor, I aim for the most optimal levels of thyroid hormone based on labs & patient/client symptomatology not just ‘getting it back in range’. There are numerous types of thyroid hormone medications and everyone responds differently.

What thyroid medications options are there?

  • T4-based thyroid hormone






  • T3-based


  • Animal-based glandulars (combo T4/T3, usually 4:1 ratio)

NP Thyroid




  • Compounded medications

T4 & T3 in immediate or sustained release options, medication is specifically formulated to *you* (your labs, presenting symptoms, etc) to tailor the best dose and response

This is a non-exhaustive list, however, these are the most commonly used variations I see in practice as a naturopathic doctor in a primary care setting in Arizona.

What other factors should I consider on thyroid medication?

  • Do you have an autoimmune thyroid disease worsened by gluten? Different forms of Levothyroxine and Cytomel may have fillers that aggravate your immune system. You can contact the manufacturer to double check, Tirosint has less fillers and is often better tolerated.

  • Animal-based glandulars are not always the best option for autoimmune induced hypothyroidism as it’s sometimes associated with increased immune reactivity.

  • Are you ONLY on T3 medication? This is not typically advised as it doesn’t appropriate the correct feedback loop from the pituitary gland to the thyroid and you’d likely benefit from lowering T3 and increasing T4 dosage.

  • Are you ONLY on T4 when your free T3 levels are suboptimal? You may benefit from a combo product like a glandular or compounded medication.

The thyroid gland is often a piece of the puzzle to attaining good health & energy. If it’s not functioning optimally then you may suffer from poor cognition/brain fog, mood lability, GI upset, high cholesterol, cold intolerance, and more! It’s important that you’re on the right medication for your body and specific health conditions.

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